Assisted reproductive technology ( ART ) is a technology used to achieve pregnancy in procedures such as fertility drugs, in vitro fertilization and surrogacy. It is a reproductive technology that is used primarily for fertility treatment, and is also known as fertility treatments. It mainly belongs to the field of reproductive and infertility endocrinology, and may also include intracytoplasmic sperm injection (ICSI) and cryopreservation. Some forms of antiretroviral therapy are also used with regard to fertile couples for genetic reasons (genetic diagnosis of preimplantation). ART is also used for couples who deviate to certain infectious diseases; for example, HIV to reduce the risk of infection when pregnancy is desired.
Video Assisted reproductive technology
Procedures
General
With ART, the process of sexual intercourse is bypassed and the fertilization of oocytes occurs in the laboratory environment (ie, in vitro fertilization).
In the US, the Centers for Disease Control and Prevention (CDC) - required as a result of the 1992 Success Rate and the Fertility Clinical Certification Act to publicize the success rate of annual ART at a US fertility clinic - Define ART to include " all fertility treatments in which both eggs and sperm are treated.In general, ART procedures involve surgery removing eggs from a woman's ovaries, combining them with sperm in the laboratory, and returning them to a woman's body or donating them to another woman. "According to the CDC," they excluding treatments where only sperm are handled (ie, intrauterine - or artificial insemination) or a procedure in which a woman takes medication only to stimulate egg production without the intention of taking eggs. "
In Europe, ART also excludes artificial insemination and includes only the procedure in which the oocyte is handled.
WHO also defines ART in this way.
Fertility medicine
Most fertility drugs are agents that stimulate the development of follicles in the ovaries. Examples are gonadotropin and gonadotropin release hormone.
In-vitro fertilization
In vitro fertilization is the technique of allowing the fertilization of male and female gametes (sperm and egg) to occur outside the female body.
Techniques commonly used in in vitro fertilization include:
- Transvaginal ovum retrieval (OVR) is a process in which a small needle is inserted through the back of the vagina and guided through the ultrasound into the ovarian follicle to collect the fluid containing the egg.
- Embryo removal is a step in the process in which one or more embryos are placed into the female uterus in order to form a pregnancy.
Less common techniques used in in vitro fertilization are:
- Assisted zone hatching (AZH) is performed just before the embryo is transferred to the uterus. A small opening is made in the outer layer surrounding the egg to help the embryo hatch and help the process of growing embryo implantation.
- Injection of intrasitoplasmic sperm (ICSI) is useful in cases of male factor infertility in which sperm count is very low or fertilization fails to occur with previous IVF attempts. The ICSI procedure involves one sperm being carefully injected into the center of the egg using a microneedle. With ICSI, only one sperm per egg is needed. Without ICSI, you need between 50,000 and 100,000. This method is sometimes used when donor sperm is used.
- Autologous endometrium cultivation is a possible treatment for patients who fail in previous IVF trials or who have poor embryonic quality. The fertilized egg is placed above the cell layer of the patient's own uterine lining, creating a more natural environment for embryonic development.
- In intracallopian zygote transfer (ZIFT), the egg is removed from the female ovary and fertilized in the laboratory; the resulting zygote is then placed into the fallopian tube.
- Cytoplasm transfer is a technique in which the fertile egg content of the donor is injected into the infertile egg of the patient along with the sperm.
- The egg donor is a resource for women without eggs due to surgery, chemotherapy, or genetic causes; or with poor egg quality, IVF cycles that were previously unsuccessful or advanced maternal age. In the egg donor process, the egg is taken from the donor ovary, fertilized in the laboratory with the sperm from the receiving partner, and the resulting healthy embryo is returned to the recipient's uterus.
- Sperm donations can provide a source for sperm used in IVF procedures in which male partners do not produce sperm or have congenital disease, or where women treated do not have male partners.
- Preimplantation genetic diagnosis (PGD) involves the use of genetic screening mechanisms such as in-situ fluorescent hybridization (FISH) or comparative genomic hybridization (CGH) to help identify genetically abnormal embryos and promote healthy outcomes.
- Embryo separation can be used for twins to increase the number of available embryos.
More
Other assisted reproductive techniques include:
- In intrafallopian gamete transfer (GIFT), a mixture of sperm and eggs is placed directly into a woman's fallopian tubes using laparoscopy after transvaginal ova removal.
- Sex selection is an attempt to control the sex of the offspring to achieve the desired sex. This can be done in several ways, both before and after embryo implantation, or at birth. Pre-implantation techniques include PGD, but also sperm sorting.
- Reproductive surgery, treating eg fallopian tube obstruction and obstruction vas deferens, or reversing a vasectomy with reversed vasectomy.
- In surgical sperm retrieval (SSR), the reproductive urologist obtains sperm from the vas deferens, epididymis or directly from the testes in a short outpatient procedure.
- With cryopreservation, eggs, sperm and reproductive tissue can be maintained for IVF later.
Maps Assisted reproductive technology
Risk
Most IVF infants have no birth defects. However, several studies have shown that assisted reproductive technology is associated with an increased risk of birth defects. Artificial reproductive technology becomes more available. Preliminary studies suggest that there may be an increased risk for medical complications with mothers and infants. Some of these include low birth weight, placental insufficiency, chromosomal disorders, premature birth, gestational diabetes, and pre-eclampsia (Aiken and Brockelsby).
In the largest US study, which used data from the registry across the state of birth defects, 6.2% of children in IVF contained major defects, compared with 4.4% of natural conceived children matched for maternal age and other factors (odds ratio, 1.3, 95% confidence interval, 1.00 to 1.67). ART carries a risk of heterotopic pregnancy (intrauterine and simultaneous extrauterine pregnancy). The main risks are:
- Genetic disorders
- Low birth weight. In IVF and ICSI, the risk factor is a decrease in protein expression in energy metabolism; Chain of light of Feritin and ATP5A1.
- Premature birth. Low birth weight and premature birth are closely related to many health problems, such as visual impairment and cerebral palsy, and children born after IVF are approximately twice as likely to have cerebral palsy.
Other risk factors are:
- Membrane damage, which can be reflected by the expression of NAPA and Annexin A3 membrane fusion protein expression.
Sperm donations are an exception, with birth defects being almost a fifth as compared to the general population. This can be explained by sperm banks only accept people with high sperm count.
Current data suggest little or no increased risk for postpartum depression among women on ART.
Use of assisted reproductive technologies including ovarian stimulation and in vitro fertilization has been associated with an increased overall risk of childhood cancer in offspring, which may be caused by the same disease or same condition that causes infertility or subfertility in the mother or father.
That said, In a famous paper by Jacques Balayla et al. it was determined that infants born after HAART had the same neurological development compared to babies born after natural conception.
Usage
Replacement technology assisted procedures conducted in the US have more than doubled over the last 10 years, with 140,000 procedures in 2006, resulting in 55,000 births.
In Australia, 3.1% of births are the result of HAART.
In the case of termination of fertility treatment, the most common reasons have been estimated: treatment delay (39%), physical and psychological burden (19%, psychological burden 14%, physical load 6.32%), relational and personal issues (17% personal 9%, relational problems 9%), refusal of treatment (13%) and organizational problems (12%) and clinics (8%).
Cost
United States
Many Americans do not have insurance coverage for investigations and fertility treatments. Many countries are beginning to enforce coverage, and their usage rates are 278% higher in fully scanned states.
There are several health insurance companies that include a diagnosis of infertility but are often diagnosed will not cover the cost of care.
2005 estimated cost of care/diagnosis (United States, cost in US $):
- Initial examination: hysteroscopy, hysterosalpingogram, blood test ~ $ 2,000
- Sonohysterogram (SHG) ~ $ 600- $ 1,000
- Clomiphene citrate cycle ~ $ 200- $ 500
- IVF cycle ~ $ 10,000 - $ 30,000
- The use of surrogate moms to bring children - depends on the setting
Another way to look at costs is to determine the expected cost of building a pregnancy. So if clomiphene treatment has an opportunity to build a pregnancy in 8% cycles and costs $ 500, the expected cost is $ 6,000 to build a pregnancy, compared to the IVF cycle (40% fecundity cycle) with an approximate cost of $ 30,000 ($ 12,000/.4).
For the community as a whole, the average IVF fee pays back 700% by taxes of future work by the humans it contains.
United Kingdom
In the United Kingdom, all patients have the right to conduct an initial test, administered free of charge by the National Health Service. However, treatment is not widely available in the NHS and there can be a long waiting list. Therefore many patients pay for immediate care within the NHS or seek help from private clinics.
In 2013, the National Institute for Health and Nursing Excellence published new guidelines on who should have access to IVF care on the NHS in England and Wales.
The guidelines also suggest women aged between 40 and 42 should be offered an IVF cycle on the NHS if all of the following additional criteria are also met: They have never had IVF treatment before, have no evidence of low ovarian reserve (this is when eggs in the ovaries are low in number or low in quality) and have been informed of the additional implications of IVF and pregnancy at this age. However, if tests indicate IVF is the only treatment that might help them get pregnant, women should be referred for IVF directly.
This policy is often modified by the local Clinical Commission Group, in considerable violation of the NHS Constitution for the United Kingdom which provides that patients have the right to medications and treatments recommended by NICE for use in the NHS. For example, Cheshire, Merseyside and West Lancashire Clinical Commissioning Group emphasize additional provisions:
- The person undergoing treatment should have started treatment before his 40th birthday.
- The person undergoing treatment should have a BMI between 19 and 29.
- Partners may not have surviving children, either from current or previous relationships. This includes adopted children as well as biological children.
- Sub-fertility should not be a direct result of a sterilization procedure in one pair (this does not include conditions where sterilization occurs as a result of other medical problems). Couples who have reversed their sterilization procedures are not eligible for treatment.
Swedish
In Sweden, official fertility clinics provide the most needed care and preliminary checks, but there is a long waiting list, especially for egg donations, as donors receive equally low rewards by accepting spouses. However, there is a private fertility clinic.
Canada
Some treatments are covered by OHIP (public health insurance) in Ontario and others are not. Those who have tubal fallopian tubes bilaterally and under 40 years already get treatment but still have to pay lab fees (about $ 3,000-4,000). Coverage varies in other provinces. Most other patients are required to pay for their own treatment.
Israel
Israel's national health insurance, which is an obligation to all Israelis, covers almost all fertility treatments. IVF costs are fully subsidized until the birth of two children for all Israeli women, including single women and lesbian couples. Embryo transfer for gestational purposes of pregnancy is also discussed.
New Zealand
New Zealand's national public health system includes IVF care in special circumstances, based on 'points for conception challenges'. Limited publicly funded IVF treatment (between one and three treatments depends on the criteria) and subject to a substantial waiting list, depending on the local health funding area, which increases the potential for ART-supported inequality across the country. Infertility tests through blood tests may be covered by public funding, but in the absence of obvious gynecological complications, additional investigations may not be discussed publicly. Investigations such as hysterosalpingogram may be covered, but waiting lists can be longer than six weeks, while private source HSG can cost $ NZ900 but is readily available. Many New Zealanders choose self-funded IVF cycles, about $ NZ10,000 per cycle, and other forms of ART, such as IUI, about $ NZ1200, using private fertility clinic services, which themselves are a thriving local industry.. Individuals who use personal services are generally not covered by New Zealand's personal health insurance policies.
German
On January 27, 2009, the Federal Constitutional Court ruled that it is unconstitutional, that health insurance companies should bear only 50% of the cost for IVF. On March 2, 2012, the Federal Council has approved a draft law from several states, which provides that the federal government provides a 25% subsidy to costs. Thus, the share of the costs borne for the couple will drop to just 25%.
Jordan
In Jordan, not everyone has insurance coverage for fertility investigations and treatments. Army troops cover military personnel for all investigations and fertility treatments. It also includes three IVF trials in cases of primary infertility. Some health insurance companies bear the diagnosis and treatment of infertility for those who have government health insurance, but will not include assisted reproduction techniques. In the private sector, there are many centers offering private care for infertility including assisted reproduction techniques. Conventional I.V.F cost 1170JD = 1654 US $, ICSI costs 1270 JD = 1797 US $ Second price includes assisted hatching. But it does not include average treatment costs between 500-700 JD equivalent of about 700-1000 US $
Ethics
Some couples find it difficult to stop treatment even though the prognosis is very bad, resulting in useless therapy. This can give the ART provider a difficult decision whether to continue or refuse treatment.
For special ethical treatment considerations, see the entries in each subarticle, e.g. In vitro fertilization, Surrogacy, and Sperm donors
Some assisted reproductive technologies may actually be harmful to the mother and child. Poses physical and psychological health risks, which may impact on the continued use of this treatment. Adverse effects can cause alarms, and they must be strictly regulated to ensure the candidate is not only mentally, but physically ready.
Fictitious representation
Films and other fictions that illustrate the emotional struggle of assisted reproductive technology have progressed in the latter part of the 2000s, although this technique has been available for decades. However, the number of people who can relate it to personal experience in one way or another continues to grow, and the trials and struggles are enormous.
For specific examples, see the fiction sections in each subarticle, e.g. surrogacy, sperm donors and fertility clinics.
In addition, reproduction and pregnancy in speculative fiction have been present for decades.
See also
- An artificial uterus
- Diethylstilbestrol
- Human cloning
- Mitochondrial Donation
- Religious response to ART
- The sperm bank
- Sperm donation
- Spontaneous concept, conception without help from the next child after the use of previous dedicated reproductive technology
- The Fertility Chase (medical documentary series)
References
External links
- Centers for Disease Control and Prevention (CDC), Guided Reproductive Technologies
Source of the article : Wikipedia
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